[orangefan1974]

Multiple myeloma or leukemia or ... ?

by orangefan1974 on Tue Jun 02, 2015 2:25 pm

Hello all,

I am brand new to the Beacon here and need to post this.

I have been diagnosed for three years now as a chronic lymphocytic leukemia patient. I switched oncologists / hematologists recently and said I have had certain blood tests that were alarming and needed further testing. He said I may have multiple myeloma instead, which of course would be far worse.

I am now going to a leukemia / lymphoma specialist and he ran completely new blood work last week, and I am getting my first bone marrow biopsy this Thursday. My specialist has not mentioned any other cancer yet, but he said we got to get to the bottom of why my anemia keeps gradually worsening. I do extensive research on my own so I am fairly well informed.

Can you guys have a lot and tell me what you think for the possibility of having multiple myeloma?

My blood results are as follows:

Total protein 9.3
Kappa free light chain 16.44
Kappa/Lambda Ratio 13.26

IgG 3342
IgA 59
IgM 19

Gamma 3.3,
Paraprotein 3.1,location para gamma, interpretation: M-spike present - Hypo­gamma­globu­li­nemia in the presence of paraprotein.

Homocysteine 20
WBC 13.9
RBC 3.2
Hemoglobin 9.1
Hematocrit 28
Platelets 306
Lymphocyte % 62.6
Lymphocyte 8.7

Calcium 8.7
Alk phos 23

FISH PANEL shows no deletions, and flow cytometry shows positive for chronic lymphocytic leukemia (CLL) with a slight positive of FMC7 (which is unusual for CLL).

Thank you and God bless you all.

[antelope1225]

Re: Multiple myeloma or leukemia or ... ?

by antelope1225 on Tue Jun 02, 2015 4:44 pm

Hi Orangefan1974.

I am sorry to hear of your health struggles and I can see that your blood work is not right, but it does not look to me like multiple myeloma because 3 of the 4 diagnostic criteria for multiple myeloma are not showing up in your post.

Your Calcium looks OK to me - and that is the C in CRAB (an acronym for defining characteristics of multiple myeloma that are used in diagnosing multiple myeloma)
R (Renal involvement) - do you have problems with your kidneys?
A (Anemia) - Yes, I see that your Hemoglobin and hematocrit and RBC are all a bit low.
B (Bone lesions) - do you have any bone lesions?

So, while your Kappa/Lambda ratio is higher than normal, you are anemic and your protein is high, your calcium is OK and you do not mention renal problems or bone lesions. If you have no problem with bone lesions, or your kidneys and your calcium is OK, you might have something else rather than multiple myeloma.

Good luck.


Cathy

[orangefan1974]

Re: Multiple myeloma or leukemia or ... ?

by orangefan1974 on Tue Jun 02, 2015 5:36 pm

Hi Cathy,
I have had several CT-scans over three years, and nobody ever mentioned bone lesions. However, not to long ago I had a little kidney insufficiency, but I was put on 300mg of Allopurenol and all is within normal limits now so I'm not sure if that counts in that CRAB. I know with anemia, and also with CLL you can develop some renal issues so I don't know. Anyways, thanks for reading and answering.


God bless,

Joe

[blair77]

Re: Multiple myeloma or leukemia or ... ?

by blair77 on Sat Jun 06, 2015 1:32 am

I believe you actually only have to have 1 of the 4 criteria of CRAB to be diagnosed with multiple myeloma. Actually, I'm certain, as my husband was diagnosed with multiple myeloma and did not have high calcium, renal impairment, or bone lesions. He was diagnosed with multiple myeloma due to an M spike, anemia, and a bone marrow biopsy (BMB) showing 20% plasma cells. Does your BMB mention plasma cell percentage?

[Multibilly]

Re: Multiple myeloma or leukemia or ... ?

by Multibilly on Sat Jun 06, 2015 8:08 am

I think Blair has the right take on this. Let's be clear that in order for one to be diagnosed with symptomatic multiple myeloma that one only needs to meet one of the four CRAB criteria (or have a myeloma defining event, such as a bone marrow plasma cell % > 60, or a free light chain ratio > 100).

I'm assuming that the paraprotein level is expressed in g/dL. That's not a trivial paraprotein level (M-spike). And it appears to be of IgG-type, since your IgG level is raised.

A hemoglobin level of 9.1 g/dL is pretty low. A level of 11.4 g/dL or 2.0 g/dL below the normal reference range technically meets that "A" (anemia) in the CRAB.

The bone marrow biopsy results will be able to tell you definitively if there is multiple myeloma present. It's visually obvious when you inspect the bone marrow specimen under a microscope. You can see what a bone marrow sample with multiple myeloma cells looks like here:

http://www.myelomapennstate.net/Contents/13-Diagnosis-1.htm .

There are also some other markers that will be present when they run all the bone marrow biopsy tests. It is good that you apparently have clean FISH results (there are other mutations other than just "deletions" to worry about, but I take it that the report did not highlight any of those mutations). And as Blair asked, you should be looking for a bone marrow plasma cell percentage number somewhere in the report.

Now, having said all this, I am not qualified to say how CLL would impact any of these numbers. CLL can also raise one's paraprotein level and lower one's hemoglobin levels, so a bone marrow biopsy and a specialist are what is needed to really interpret what is going on here.

If there is a suspicion of multiple myeloma, I would really suggest seeking out a multiple myeloma specialist to further interpret the results.